| Abstract
| - BACKGROUND: Infection with human papillomavirus (HPV) type16 has been implicated as a risk factor for esophageal squamous cellcarcinoma in three seroepidemiologic studies. We conducted a larger,population-based study to verify this association and to investigatepossible confounding factors. METHODS: We performed anationwide case-control study in Sweden of HPV16 or HPV18 infectionand risk of esophageal squamous cell carcinoma oresophageal/gastroesophageal adenocarcinoma. Tumors were strictlyclassified by their location and histologic type. Case subjects withincident cancers and population-based control subjects donated bloodsamples and were interviewed in person about potential confoundingfactors. An enzyme-linked immunosorbent assay was used to detect HPVseropositivity. Multivariate analyses were conducted to studyrelationships between HPV seropositivity, level of education, smoking(all tobacco) status, alcohol consumption, and cancer risk.RESULTS: We compared 121 case subjects with esophageal squamouscell carcinoma and 173 case subjects with adenocarcinoma of theesophagus or gastroesophageal junction with 302 population-basedcontrol subjects. The age- and sex-adjusted odds ratios (ORs) forsquamous cell carcinoma were 1.0 (95% confidence interval [CI] =0.5-2.0) for persons seropositive for HPV16 and 0.5 (95% CI =0.2-1.1) for persons seropositive for HPV18 in comparison withseronegative individuals. The corresponding ORs for adenocarcinoma were1.2 (95% CI = 0.7-2.2) and 0.2 (95% CI = 0.1-0.7),respectively. Adjustments for smoking status, alcohol consumption, andlevel of education did not alter the results. CONCLUSIONS: Wefound no evidence of a positive association between HPV16 or HPV18infection and either form of esophageal cancer. Our results do notsupport conclusions from previous studies.
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